Some More Perspective

Recently, I wrote about Samantha Burton being forced to submit to bed rest and a c-section, and I basically said that both parties probably made some poor decisions, and maybe it would have been better if both mom and OB had quit their working relationship and mom had found another care provider.

Then, Mom's Tinfoil Hat made a comment-turned-post in her blog, and had a point I found interesting: just because a woman is smoking doesn't necessarily mean she doesn't care about herself or her baby, or even that she's headed for disastrous consequences. I particularly like when she said,

"We all have our priorities. Exercise has also been associated with pregnancy loss. I wonder what you think of women who are selfish enough to take epilepsy meds."

Whether Samantha was making the right decisions or not isn't the focus of the court; the point to her case is that she was barred from exercising her right to choose her own course of action. The writer of another article about Samantha's situation (which I can't put my fingers on right now) said something to the effect of, "At what point do women's decisions render them incubators and wards of the state?"

I've been thinking a lot about smoking in pregnancy, and a client of mine recently let me know that she was smoking through probably about her 20th week of pregnancy, tapering back slowly until she had quit altogether. My personal decision to not serve women who are pregnant and still smoking seemed to dissipate suddenly when she told me this - I had been offering her support through her pregnancy already, and her smoking status didn't change the fact that I've helped her thus far by providing research, information and resources to her. Maybe she needed my support in these ways while she worked through her decision to quit smoking, and maybe without my support she wouldn't have made it to the point of quitting. And even if she didn't quit, she still needs me at her birth, I'm her primary point of support (after her medical care provider).

This is all very thought provoking. I think I'll go ruminate upon it all some more.

Perspective

Everyone's shaking a finger, either at Samantha Burton or her OB.

Ms. Burton experienced something many of us would consider a worst case scenario: she lost her baby at 25 weeks gestation. And as if that isn't terrible enough, she was held against her will at the hospital when a court ordered her to comply with her OB's recommendation of bed rest. Finally, her OB performed a cesarean in hopes that her baby could be saved - only to discover that fetal demise had already occurred.

A big question echoing in many conversations about this situation is, at what point does a pregnant mom become incapable of deciding what is best for herself and her baby? Ms. Burton was smoking during pregnancy, which is acknowledged by pretty much every care provider out there to be a bad thing. But even if she was making a bad decision, isn't it still her decision to make? That's the crux of the arguements against her OB's decision to initiate a process to hold this mom against her will: freedom to choose.

Last year, I interviewed with a potential client who had two older children, both born premature and with physical and mental abnormalities, who was also a smoker. I didn't contract with this client, simply because I knew, after our interview, that I was not the right person to help her. There were a few reasons why, but the second most important one was because I'm so utterly opposed to smoking, whether one is pregnant or not. Cigarettes are laden with chemicals that are not supposed to be in the body in any amount.

This became a deal breaker for me; my personal feelings about smoking aren't something which can be negotiated around, I can't support someone who wants to continue to smoke when I believe it's a bad decision which puts the lives of both mother and child in danger. I wonder why Ms. Burton's OB decided to go through all of the effort to keep her in the hospital and eventually perform surgery - was it not an option to refer her care to another doctor?

Maybe it's not that simple, I don't know.... The Hippocratic Oath does basically say you can't refuse to help someone when you become a doctor. I know there's probably many more details about Ms. Burton's situation which caused her OB to steer her care in the direction it went. It was a bad situation for both mother and care provider, and maybe both of them could have made better decisions along the way. I find it difficult to take sides with either the mother or the care provider (providers, really, both the OB and the hospital) when both acted in ways with which I don't agree.

I think it's worth noting that this sort of thing is rare, and as frightening as it can be to have something like this happen practically in my own back yard, it's important to keep things in perspective. A pregnant mom in preterm labor is a challenge to any care provider; and a care provider who doesn't agree with a mother's choices during pregnancy is a challenge for that mother. It seems a little paradoxical, but rising to the challenge sometimes means walking away.